Arthroscopic Tibio-talar Calcaneal Nailing for Complex Distal Third and Intra-Articular Tibia Fractures

Abstract

Distal tibia fractures are complex injuries with a high complication rate and unclear guidelines regarding operative timing for reduction and fixation. A tibial plafond fracture, or pilon fracture, is a fracture of the distal end of the tibia, often associated with complex comminuted fragments and surrounding soft-tissue injury compromise. Appropriate management of distal tibial and pilon fractures remains a challenge and existing research proves current surgical approaches have poor clinical outcomes. We propose that primary hindfoot arthrodesis using a tibio-talar calcaneal nail may be used as a successful method for treating complex distal tibial and pilon fractures, notably in those with coexisting medical comorbidities (diabetes, neuropathy, dementia, and compromised soft-tissue). The overall perioperative complication rate in this high-risk cohort may be reduced given a lesser invasive method for fixation. We hypothesize that primary hindfoot arthrodesis using an arthroscopic preparation and tibio-talar calcaneal nail for periarticular ankle trauma is a safe and effective surgical approach with optimal fracture alignment and stability. Level of Evidence: Level V.